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| Fig. 62.1 Coccidioidomycosis. Disseminated coccidioidomycosis in a young black soldier. (Courtesy of the Fitzsimons Army Medical Center teaching files.) |
Coccidioidomycosis, also known as San Joaquin Valley fever, is a deep fungal infection caused by
Coccidioides immitis. It is typically acquired via inhalation of arthrospores and demonstrates occasional hematogenous dissemination to subcutaneous tissues, bone, or skin. Endemic areas include the Sonoran life zone of southern California, Arizona, New Mexico, southwestern Texas, and northern Mexico. It has also been reported in certain areas of South America. Infection occurs equally in both sexes, and in all races and ages. For reasons that are not entirely clear, black persons are 14 times more likely to have severe disseminated disease than are caucasians (Fig. 62-10), and individuals of Filipino descent are 10 times more likely to develop coccidioidomycosis-related meninigitis than caucasians. Further investigation has revealed that certain host genetics, in particular the human leukocyte antigen (HLA) class II and ABO blood group genes, influence susceptibility to severe coccidioidomycosis.
Untreated, nonmeningeal coccidioidomycosis has a 50% mortality rate; therefore, early aggressive treatment with systemic antifungal agents is essential.
Louie L, Ng S, Hajjeh R, et al: Influence of host genetics on the severity of coccidioidomycosis,
Emerg Infect Dis 5:672–680, 1999.
Pappagianis D: Epidemiology of coccidioidomycosis,
Curr Top Med Mycol 2:199–238, 1988.
